Patient Resources

Patient Forms

• Adult Health History Form 
• Patient Information Form - English 

Patient Education

• Multiple food allergies 

Web Resources

• Advance Care Planning 
• Intermountain Healthcare Health Resources by Topic 
• My Health 
• Personalized Primary Care 
• Symptom Checker 

Patient Education

• Asthma: Breathing Easier booklet 
• Asthma: Breathing Easier booklet - How to Use a Nebulizer 
• Asthma: Breathing Easier booklet - Symptoms and Triggers 
• Asthma: Breathing Easier booklet -How to Use a Press and Breathe 

Patient Forms

• Child/Adolescent Baseline Evaluation Packet 
• Child/Adolescent Follow-up Evaluation Packet 

Patient Education

• ADHD Attention Deficit Hyperactivity Disorder handout 
• ADHD Attention Deficit Hyperactivity Disorder handout Spanish 
• ADHD Behavior Tracking Sheet 
• ADHD Daily Schedule 
• ADHD Magic Grid 

Patient Education

• Facts About Heaing Loss (American Academy of Audiology) 
• Hearing Acuity (American Academy of Audiology) 
• Hearing Loss in Children (American Academy of Audiology) 
• Noise-Induced Hearing Loss (American Academy of Audiology) 
• Turn It To the Left! (American Academy of Audiology) 

Web Resources

• American Academy of Audiology 

Patient Education

• Aspirin Therapy for Adults with Diabetes 
• Carb Counselor: Advice and Tools for Counting Carbs pocket guide 
• Diabetes Care Card 
• Diabetes Care Handbook: Living Well with 
• Diabetes Medication: Glitazones  
• Diabetes Medication: Meglitinides 
• Diabetes Medication: Sulfonylureas 
• Diabetes Medications: Glucagon 
• Diabetes Medications: Insulin 
• Food Finder and Meal Plan Basics handout 
• Gestational Diabetes 
• Gestational Diabetes Meal Plan 
• Pre-diabetes: Act Now to Protect Your Health 

Patient Education

• Dr. Child's Ear Tubes Handout 
• Dr. Child's Myofascial Pain Handout 
• Dr. Child's Septal Surgery Handout 
• Dr. Child's Sinus Surgery Handout 
• Dr. Child's Tonsil and Adenoid Surgery Handout 
• Ear Infections 
• OSA Obstructive Sleep Apnea 
• Post surgery care for inner ear surgery 
• Post surgery care for inner ear surgery Spanish 
• Surgical Information Tubes 
• Tonsillectomy Home Instructions 
• Tonsillectomy Home Instructions Spanish 
• Tonsils and adenoids surgery 
• Tonsils and adenoids surgery Spanish 

Patient Education

• About the Flu Vaccine 
• Flu Season is Coming 

Patient Forms

• Adult Baseline Evaluation Packet 
• Adult Follow-up Evaluation Packet 
• Child/Adolescent Baseline Evaluation Packet 
• Child/Adolescent Follow-up Evaluation Packet 
• School Baseline Evaluation Packet 
• School Follow-up Evaluation Packet 

Patient Forms

• Mohs Health History Form 

Patient Education

• Post-Operative Wound Care Instructions 
• Preparing for Mohs Surgery 
• Suture Removal & Healing FAQs 
• What is Mohs? (by Dr. Jason Hansen) 

Patient Education

• Information about Fever 
• Medications for Fever 
• Temperature Conversion Chart 

Web Resources

• IntermountainLiVE.org 

Patient Education

• Nicotine replacement therapy for quitting tobacco  
• Quitting Smoking 
• Quitting Tobacco: Your journey to freedom